Chronic Constipation in Young Adult: Seeking Diagnostic Workup for Possible Anatomical Causes

Case at a Glance

A 20-year-old female presents with lifelong chronic constipation, occurring since early childhood despite optimal dietary management and lifestyle modifications. Patient experiences bowel movements every 2-3 days with associated pain and has developed hemorrhoids.

Patient's Story

The patient reports chronic constipation dating back to toddlerhood, as confirmed by maternal history. Despite maintaining excellent dietary habits including 35-45g daily fiber intake, 2+ liters of water daily, and avoiding known constipating foods (processed foods, sugar, dairy, gluten), she continues to experience infrequent bowel movements. Her typical pattern is defecation every 2-3 days, with occasional improvement to every other day when fiber intake is maximized, though this approach becomes unsustainable due to bloating and early satiety. She has never experienced daily bowel movements throughout her lifetime.

Initial Assessment

Patient presents with chronic functional constipation refractory to dietary and lifestyle interventions. Physical examination reveals presence of hemorrhoids. Stool characteristics are reportedly normal in consistency and color, though defecation is consistently associated with pain. Recent laboratory studies have been completed in preparation for gastroenterology consultation.

The Diagnostic Journey

Given the lifelong nature and severity of symptoms despite optimal conservative management, the patient is seeking comprehensive diagnostic evaluation. She is particularly interested in investigating potential anatomical or physiological causes including slow-transit colon, pelvic floor dysfunction, rectocele, or neurological disorders affecting bowel motility.

Final Diagnosis

Pending comprehensive gastroenterological evaluation and diagnostic testing

Treatment Plan

Patient to undergo gastroenterology consultation with consideration for: anorectal manometry to assess pelvic floor function and rectal sensation, colonic transit study to evaluate motility, digital rectal examination for structural abnormalities, and colonoscopy for comprehensive luminal evaluation. Additional testing may include defecography or MR defecography if pelvic floor dysfunction is suspected.

Outcome and Follow-up

Patient scheduled for gastroenterology consultation to initiate diagnostic workup. Healthcare provider confirmed appropriateness of requested studies given symptom severity and duration. Awaiting results of comprehensive evaluation to guide targeted therapeutic interventions.